Changes in Pediatric Residents' Perceptions of Their Continuity Experience During Their Training: A National Study

Feigelman, Susan; Olsson, John; Drutz, Jan; Dungy, Claibourne I.; Lopreiato, Joseph; Serwint, Janet R.; Continuity Research Network (CORNET) of the Ambulatory Pediatric Association,

doi:10.1367/A04-137R1.1

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Volume 5, Issue 4 , Pages 221-227, July 2005

Changes in Pediatric Residents' Perceptions of Their Continuity Experience During Their Training: A National Study

Susan Feigelman, MD
- Address correspondence to Susan Feigelman, MD, University of Maryland School of Medicine, 655 West Lombard St, Ste 311, Baltimore, MD, 21201
John Olsson, MD
- From the Department of Pediatrics (Dr Feigelman), University of Maryland School of Medicine, Baltimore, Md; the Brody School of Medicine (Dr Olsson), Greenville, NC; Baylor College of Medicine (Dr Drutz), Houston, Tex; the University of Iowa (Dr Dungy), Iowa City, Iowa; Uniformed Services University (Dr Lopreiato), Bethesda, Md; and the Johns Hopkins School of Medicine (Dr Serwint), Baltimore, Md
Jan Drutz, MD
- From the Department of Pediatrics (Dr Feigelman), University of Maryland School of Medicine, Baltimore, Md; the Brody School of Medicine (Dr Olsson), Greenville, NC; Baylor College of Medicine (Dr Drutz), Houston, Tex; the University of Iowa (Dr Dungy), Iowa City, Iowa; Uniformed Services University (Dr Lopreiato), Bethesda, Md; and the Johns Hopkins School of Medicine (Dr Serwint), Baltimore, Md
Claibourne I. Dungy, MD, MPH
- From the Department of Pediatrics (Dr Feigelman), University of Maryland School of Medicine, Baltimore, Md; the Brody School of Medicine (Dr Olsson), Greenville, NC; Baylor College of Medicine (Dr Drutz), Houston, Tex; the University of Iowa (Dr Dungy), Iowa City, Iowa; Uniformed Services University (Dr Lopreiato), Bethesda, Md; and the Johns Hopkins School of Medicine (Dr Serwint), Baltimore, Md
Joseph Lopreiato, MD, MPH
- From the Department of Pediatrics (Dr Feigelman), University of Maryland School of Medicine, Baltimore, Md; the Brody School of Medicine (Dr Olsson), Greenville, NC; Baylor College of Medicine (Dr Drutz), Houston, Tex; the University of Iowa (Dr Dungy), Iowa City, Iowa; Uniformed Services University (Dr Lopreiato), Bethesda, Md; and the Johns Hopkins School of Medicine (Dr Serwint), Baltimore, Md
Janet R. Serwint, MD
- From the Department of Pediatrics (Dr Feigelman), University of Maryland School of Medicine, Baltimore, Md; the Brody School of Medicine (Dr Olsson), Greenville, NC; Baylor College of Medicine (Dr Drutz), Houston, Tex; the University of Iowa (Dr Dungy), Iowa City, Iowa; Uniformed Services University (Dr Lopreiato), Bethesda, Md; and the Johns Hopkins School of Medicine (Dr Serwint), Baltimore, Md
Continuity Research Network (CORNET) of the Ambulatory Pediatric Association

Received 5 August 2004; accepted 11 March 2005.

Objective.—To determine how pediatric residents' perceptions of continuity clinic experiences vary by level of training, after controlling for the effect of continuity setting.

Method.—Cross-sectional survey of pediatric and combined pediatric trainees in US residency programs.

Results.—Survey responses were received from 1355 residents in 36 training programs. Residents' continuity experiences were in hospital-based and community settings. Numbers of patients seen increased between PGY-1 and PGY-3 years, but not in the PGY-4 and PGY-5 years. Compared to PGY-1 residents, PGY-2 and PGY-3 residents were more likely to report more encounters with established patients, but were not more likely to feel like the primary care provider. There were no significant differences by training level in terms of involvement in panel patients' laboratory results, hospitalizations, or telephone calls, although nursery involvement decreased with increasing training level. Autonomy was directly related to training level. The perception of having the appropriate amount of exposure to practice management issues was low for all respondents.

Conclusions.—Residents perceived that they had greater autonomy and continuity with patients as they become more senior, yet they were not more likely to feel like the primary care provider. Lack of increased involvement in key patient care and office responsibilities across training years may reflect a need for changes in resident education. These data may be helpful in formulating recommendations to program directors with regard to determining which Accreditation Council for Graduate Medical Education competencies should be emphasized and evaluated in the continuity experience.

KEY WORDS: Accreditation Council for Graduate Medical Education , competencies , continuity , resident education , training level